Muhammad Ali Qadeer ( Department of Gastroenterology, Dr. Ziauddin University Hospital, Karachi, Pakistan. )
Zaigham Abbas ( Department of Gastroenterology, Ziauddin University Hospital, Karachi, Pakistan. )
Madam, Recent guidelines for the prevention of COVID-19 advocate that all the elective procedures should be postponed as these produce aerosols that may affect the staff engaged. Sagami R et al and Neven L et al published the use of a barrier box to prevent the spread of droplets.1,2 We have done some modifications to this technique.
Our endoscopic shield is made of three plastic square walls with a height and width of 50 cm and a length of 40 cm. The wall facing the patient has a hole of 10cm for insertion of the scope. The foot and head sides of the cube are left open. The opening in the head side helps the assistant to keep the patient in proper position, along with the mouth-piece and nasal prong. One may argue that it would lead to the spread of droplets but the previous study has shown that the droplets fall more on the wall facing the patient’s mouth, hence placing the surgical mask over the patient’s face further reduces the head-ward spread of droplets.3 This also helps to facilitate the to and fro movement of the box so that the intubation hole moves away and the intact part of the front wall faces the mouth.
A surgical mask with a small hole is placed in a way that the hole is aligned with the mouthpiece hole. The shield is placed over the patient’s head. The scope is passed through the endoscopic port made in the wall of the shield facing the patient and endoscopy is performed.
This technique has a few advantages. First, it gives free access to the assistant during the procedure. Second, putting the face mask further reduces the risk of the spread of droplets. Third, an appropriate window for endoscope insertion allows the operator to work at ease, especially during challenging procedures.
Disclaimer: None to declare.
Conflict of Interest: None to declare.
Funding Sources: None to declare.
1. Sagami R, Nishikiori H, Sato T, Murakami K. Endoscopic shield: barrier enclosure during the endoscopy to prevent aerosol droplets during the COVID-19 pandemic. VideoGIE. 2020; 5: 445-8.
2. Ljubicic N, Stojsavljevic-Shapeski S, Virovic-Jukic L, Nikolic M. Plexiglas barrier box to improve ERCP safety during the COVID-19 pandemic. Gastrointest Endosc. 2020; 92: 428-429.
3. Canelli R, Connor C, Gonzalez M, Nozari A, Ortega R. Barrier Enclosure during Endotracheal Intubation. NEJM 2020; 382: 1957-1958.